A digest of events, trends, issues, ideas and journalism from and about rural America, by the Institute for Rural Journalism and Community Issues, based at the University of Kentucky.
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Saturday, December 07, 2013

A summit to face the crises of Eastern Kentucky, called for Monday, Dec. 9, by the area's Republican congressman and the state's Democratic governor, has attracted more than 1,500 registrants and will be telecast by the state's television network and the region's TV station. The Lexington Herald-Leader has a scene-setter story, here. UPDATE, Dec. 8: the paper's opinion section today and tomorrow is devoted to the issue, and columnist Tom Eblen writes about it.

Bill Goodman of Kentucky Educational Television writes, "We’ll provide live coverage of the summit starting
at 9 a.m. on KETKY and online at KET.org/live. Along the way, I’ll have
interviews with various participants to get their perspectives on the
day’s events. If you can’t watch our live coverage, you can follow this blog
and my Twitter account
for an ongoing synopsis of the presentations." Goodman also notes the Facebook page "that Gov. Steve Beshear and U.S. Rep. Harold "Hal" Rogers have established for the "Shaping Our Appalachian Region" project, and a wrap-up show with Beshear and Rogers, to be telecast on KET's main channel at 8 p.m. ET.

WYMT-TV in Hazard, a CBS affiliate, says it will broadcast the summit live from 9 a.m. to noon and 1 to 5 p.m., with continuous coverage on its website.

The summit is being held in Pikeville, seat of Kentucky's easternmost county, which borders Virginia and West Virginia. The impetus for the effort is the recent loss of 6,000 jobs in Eastern Kentucky's coal industry, which has dominated the region for a century but is suffering from depletion of easily mined coal, competition with natural gas, and new environmental regulations. The effort is being helped by the Appalachian Regional Commission and the Rural Development branch of the U.S. Department of Agriculture, and Rural Policy Research Institute CEO Charles Fluharty is the facilitator.

The effort is aimed at finding long-term solutions to the region's economic problems, but in an editorial this week, The Mountain Eagle of Whitesburg called for a public-works jobs program like the Civilian Conservation Corps that President Franklin D. Roosevelt created soon after he took office during the Great Depression. The weekly suggested that the program and other efforts could be funded with $2.5 billion in the federal fund to reclaim abandoned mines, which is funded by a national severance tax on coal.

The editorial said, in part: "In addition to the problems unemployed coal miners and their families face, thousands of young men and women are living in the region without much hope today — stuck in poverty, nothing to look forward to, no obvious reason to stay in school, not much chance of finding a job, dealing and doing drugs because that’s what their peers are mostly doing. Could a new CCC help? We’ll never know unless we try. Plenty of regional projects that are still being planned or under way could be scaled up. . . . National and state parks have been underfunded for 25 years, and they’re showing the stress from heavy wear and tear. There are thousands of shovel-ready improvements on administrators’ wish lists. Walk the 1,200-mile-long Appalachian Trail: you’ll see that many if not most of the shelters are in disrepair. Explore our hollows: streams need to be restored, back-road bridges rebuilt, trash picked up, the homes of the elderly weatherized — there’s more than enough work to be done." (Read more; subscription may be required)

Friday, December 06, 2013

The Farm Bill continues to hit snags, as soybean and corn interest groups push congressional negotiators for measures favorable to them. That has the negotiators to test new options "for paying crop subsidies on some variation of a farm’s historic base acres — rather than what’s actually being planted each year," David Rogers reports for Politico. "The reversal dashes early hopes — shared by the House and Senate — to adopt a more transparent system of paying on planted acres. Indeed, a major criticism of the current direct cash payments to farmers is that the money goes out regardless of what is being planted, if anything at all."

"The rough goal now is to pay on 85 percent of base acres for both the new revenue and price loss programs in the proposed commodity title," Rogers writes. "But much depends on what scores come back from the Congressional Budget Office Monday. And at this stage it seems almost certain that the House will not vote before it goes home next Friday, Dec. 13." That has spurred talk of a short-term extension of current farm law to some date in January.

House Speaker John Boehner told
reporters the House is ready to give farm-bill negotiators a short-term extension, and House
Agriculture Committee Chairman Frank Lucas indicated on Farm Journal's "AgriTalk" this week that negotiations may run into next month, Chris Clayton reports for DTN/The Progressive Farmer.

Rogers reports, "Midwest Republicans in the Senate, allied with corn and beans, were most adamant that base acres be used for a new target price program advocated by the House. But as corn prices have fallen over the summer, the Senate’s own revenue protection option — paid on planted acres —became vulnerable to the same complaint. Last week the National Corn Growers Association and American Soybean Association, which had supported planted acres themselves, warned they would oppose the bill unless all payments were decoupled from current production."

What this means is that "special accommodations will have to be made for millions of 'orphaned' cotton base acres, no longer qualifying for the commodity programs," Rogers writes. "At the same time, negotiators are testing what it will cost if farmers were to be allowed to reallocate plantings within their base. Such a reallocation seems almost certain for farms with a cotton base [that] have been planting other crops in recent years. But if done on a national scale, the costs could be high given the expansion of corn."

"Corn and soybeans’ victory in this case comes at the expense of those Midwest farmers who had been hoping that aid would be distributed according to average planted acres of recent years. In many cases that would be significantly higher than a farm’s base acres," Rogers writes. "The other side of the coin is that the drop in corn prices means that corn growers will very likely qualify for generous assistance under the new Agriculture Risk Coverage program, which is the mainstay of the Senate’s commodity title. So much so, that if corn were to reach $4 per bushel in 2014, a farmer could double what he now gets in direct cash payments—paid on base acres." (Read more)

As many rural communities continue to struggle to attract new family physicians, a study by researchers at the Robert Graham Center says that where doctors practice their residency is the key to bringing more doctors to rural America. The study, which used information from the 2009 American Medical Association Physician Masterfile, found that 19 percent of family-medicine residency program graduates stay within five miles of their residency program site, and 39 percent locate within 25 miles. (Graham Center graphic)

"The distribution of physicians continues to compromise
access to primary care, a problem compounded
by limited volume of training outside of major metropolitan
areas and large academic health centers," the study report says. "More
research is needed to explore the influences of practice
site other than training location, but these findings seem
to support current efforts to decentralize graduate medical
education training through models such as teaching
health centers and rural training tracks." (Read more)

Nine of the nation's 22 best rural hospitals are in Maine and four are in Tennessee, according to the Leapfrog Group's 2013 list of top hospitals, chosen from 1,324 hospitals that answered a survey.

The number of rural hospitals on the list was a 69 percent increase from last year. The list also included 55 urban hospitals and 13 children's hospitals. Leah Binder, president and CEO of Leapfrog, said in a release: "The larger group of rural hospitals represented, including several critical-access hospitals, shows us that any hospital in America can achieve the highest standards of quality and safety, and any community, no matter how small, can benefit from top-notch health care.”

There are 400,540 foster children in the U.S., according to the Congressional Coalition on Adoption Institute. Finding families to adopt these children, or merely giving them a safe home where they feel accepted, can be difficult, especially in rural areas like Alaska, where 14.8 percent of the population is Native American. Of the 2,100 foster Alaskan youth placed in foster homes, 1,276 are Alaska Natives, and only 413, or 32 percent, have been placed with Native families, Carey Restino reports for The Arctic Sounder. Despite the Indian Child Welfare Act of 1978, "which
requires states to do everything in their power to keep Native American
children with their families, or at the very least with Native American
families that the child’s tribe designates," the problem still exists in Alaska, and other states, Lauren Kawana reports for Oakland North. In 2012 in California, 439 Native American children entered foster care, a rate of 1.2 percent. Native American children "account for nearly 1 of every 10 foster children in Nebraska," up from 1 out of every 14 last year, Martha Stoddard reports for the Omaha World-Herald. Similar problems have occurred in every state with high Native American populations, such as Utah, New Mexico, and South Dakota.
What makes Alaska different are its many small, remote settlements, which makes it hard to attract Natives to become involved in being foster parents, Restino writes. Training and "support is often a plane ride away for rural
community foster parents, and the system can be daunting to navigate
without an advocate nearby to talk to." Plus, small-town life isn't ideal for fostering. "While in a larger community, foster parents —
relative or not — may have some anonymity, in a small town, they are
likely to bump into the children’s parents in the grocery store or
elsewhere around town."

Christy Lawton, director of the state Office of Children’s Services, told Restino of moving a child from a remote town to a larger community: “It’s like going from Alaska to New York City. That’s what it compares to in terms of the shock.” Aileen McInnis, director of the Alaska Center for
Resource Families, a nonprofit organization that the state pays to train and support foster families, told Restino: “When kids are taken out of their community, they
lose that really valuable cultural connection. It’s very
important to keep kids connected with their culture.” The state has 1,300 licensed foster homes. But changes could be coming soon. Democratic Rep. Les Gara, who was a foster child, has begun a campaign to educate and promote fostering throughout the state, Restino writes. "Gara has worked with colleagues to spearhead
reforms to reduce Alaska’s foster parent shortage, provide mentors for
youth coming out of care, and to increase the accessibility of college
and job training to help foster youth succeed. As well, a statewide TV
advertisement campaign by the Department of Health and Human
Services titled 'One Child' recently won an award for its effort to recruit new foster parents." (Read more)

Thursday, December 05, 2013

"The Arizona Industrial Commission Wednesday approved $559,000 worth of fines against the Arizona State Forestry Division in relation to the June 30 deaths of 19 Hotshot firefighters saying the division "placed a higher priority on protection of homes and property than firefighter safety," reports the Daily Courier in Prescott, where the firefighters were based. Only one Hotshot survived the fire. (Courier photo: Hotshots reach the fire June 30)

According to the commission's report, the firefighters died because they weren't removed from harm's way immediately—consistent with policies. "The report says 61 more firefighters in nearby locations to unacceptable and unnecessary risks of 'smoke inhalation, burns and death,'" Dennis Wagner, Yvonne Wingett Sanchez and Sean Holstege report for The Arizona Republic.

The fines amount to $70,000 plus $25,000 for each firefighter who died. This is the full allowed amount for a "willful" violation, which doesn't denote malice but knowing negligence. "Investigators said key safety and planning positions on the Incident Command Team were not filled as required, and other important supervisors arrived late or abandoned their posts, increasing the risk to firefighters in the field," the Republic reports. "It became an emergency because of bad planning," the state's Division of Occupational Safety and Health safety compliance supervisor Marshall Krotenberg said. (Read more)

The Rural Data Portal is a handy website that provides national, state and county information on a wide range of topics, providing "essential information on the social, economic and housing
characteristics of communities in the United States," according to the
site. Indicators allow users to click one of five subject areas—demographics, social, economic, housing and housing finance—and view results by state and county. Each indicator has a series of subsets, allowing users to get more detailed information. Most of the information comes from the Housing Assistance Council.

Demographics include reports on geographic residence, population, gender, age, race/ethnicity, Hispanic or Latino origin, households and household relationships. The economic tool provides data on employment, occupation, class or worker, industry, household income, earnings and individual and family poverty status. The social indicator has data on education attainment, marital status, grandparents as caregivers and nativity and place of birth. There is also an interactive map that shows poverty rates in each state and county.

Eula Hall has been called an angel, dynamite, a force to be reckoned with, and a living legend. She has dedicated her life to combating poverty in Appalachia and providing health care to those in need. Some say that she has done more for health care in Eastern Kentucky than any other single person.

Even at age 86, Hall continues to fight against poverty, providing health care to those who need it. Hall’s story will be told in a new biography, Mud Creek Medicine: The Life of Eula Hall and the Fight for Appalachia, written by Pikeville native Kiran Bhatraju.

Hall grew up in Pike County and moved to the Mud Creek community in adjoining Floyd County at the age of 16. She witnessed the devastating impact of poverty, including lack of health care, and became a staple in the Mud Creek community, someone to whom people would turn when they were sick or hungry.

In 1973, at age 46, Hall opened the doors to The Mud Creek Clinic in Grethel, Ky., a rural community in Floyd County, with a $1,400 donation and the help of two local doctors. The clinic rented space at first, but Hall quickly moved her family out of a nice home in Mud Creek so the home could be converted into a clinic to provide health care regardless of patients' ability to pay.

For 40 years, Hall’s clinic has weathered hard times, reports Jonathan Meador of WKMS News. But, with resiliency and the help of the community, the clinic now operates in five locations and continues its mission: To provide Appalachia’s poorest residents with health care and dental services they can afford.

Hall says things have improved in Appalachia in the last 40 years, but she is still concerned that growing income inequality in America is leaving too many of her patients behind, reports Meador. Appalachians still face numerous economic and health disparities that are deeply rooted in poverty.

"We still have people who don't have enough to meet their needs," Hall told Meador. "These are good people; these are honest people, hard workin' people, when they were able. But you know, they're disadvantaged now, and they just don't have the means to meet their needs and stuff, and somebody has to be concerned; somebody has to look out for 'em."

Bhatraju says that proceeds of his book will go toward funding the clinic. Click here to purchase a copy of the book.

Education Week compiled an extensive report—including stories, videos, pictures and graphics—discussing the educational and economic situation in Indian Country and providing a glimpse of the struggles some of these families encounter.
Nearly 40,000 members of the Oglala Lakota Sioux nation live on the 2.8 million-acre Pine Ridge Indian Reservation. "Families that have been poor since the U.S. government forced tribes onto reservations more than 120 years ago see few prospects for breaking out of seven or eight generations of profound poverty," Leslie Maxwell reports. The area has also been plagued by high rates of alcoholism and suicide, particularly in young people. "The state of American Indian education is a disaster," said David Beaulieu, a professor of education policy and community studies at the University of Wisconsin-Milwaukee and a member of the Minnesota Chippewa Tribe-White Earth.

American Indian graduation rates have been getting steadily worse since 2008, according to analyses by the research center of Editorial Projects in Education, which publishes Education Week. "It's been almost 12 years since 'No Child Left Behind' was implemented, and we essentially have no appreciable results to show for it," said Beaulieu, the director of the Office of Indian Education in the U.S. Department of Education from 1997 to 2001.

"Four of the five poorest counties in the United States fall either wholly or partly within American Indian reservations, according to the 2010 U.S. Census," Maxwell reports. The unemployment rate is around 80 percent, and Shannon County has a per-capita of less than $8,000 per year and relies on federal funding.

"We have a lot of young people on the reservation and not nearly enough jobs," said Christopher G. Bordeaux, the executive director of the Oceti Sakowin Education Consortium, a group of tribal schools in the Pine Ridge and other South Dakota reservations. "So that presents challenges to us as educators when we are trying to convince our young people to stay in school, to do well, in school, to graduate, to go on to college."

Legend Tell Tobacco, an energetic 10-year-old in 4th grade, lives on the Pine Ridge reservation. His mother, a college graduate, said, "The two most important things I want for Legend are for him to get his education and for him not to drink. But I don't know if I can completely protect him from ending up on a path that so many other youth on this reservation take." She said drinking has been a problem for many of the men in the family.

Legend attends Loneman School, which is totally dependent upon federal funding. "In 2011-12, the school struggled to nudge a little more than 25 percent of its students to proficient reading levels as measured by the South Dakota state assessments," Maxwell reports. The new principal, Charles Cuny Jr., is trying to improve the situation. "What I see children dealing with here . . . [are] the same questions of identity, cultural isolation and poverty. What I really want for our students is for them to feel positive about being Native American. I want them to see that as their biggest strength from which they can build on."

The Morongo Band of Mission Indians in California is spending its casino-generated money on a new school to battle the years of low achievement. The Morongo School opened in 2010, and it has 140 students from preschool to 9th grade. The school employed the Common Core State Standards, and the classrooms even include technology such as iPads and Apple TVs. The school works mostly free from government requirements. "We didn't want any government money," said Morongo tribal council chairman Robert Martin. "We didn't want the curriculum controlled by anyone else, and we know we are fortunate to be in that position."

A study by a Wake Forest University researcher with ties to conservation groups found that coal ash pollution caused by a recently closed coal-fired Duke Energy plant is responsible for the deaths of 900,000 bluegill every year in Sutton Lake, near Wilmington, N.C., John Downey reports for the Charlotte Business Journal. The study's author, Dennis Lemly, said
selenium poisoning is responsible for reducing the lake's bluegill and largemouth-bass population by 50 percent. Lemly "put the value of the fish killed at between $4.5 million and $7 million
per year. And he said selenium leaching from the ponds is leaving
thousands more fish deformed."

Researchers "analyzed more than 1,400 fish from Sutton Lake," with Lemly and four conservation groups saying in a statement that they "found several
species of fish showing disturbing mutations of the heads, mouths,
spines, and tails," Indian Country Today Media Network reports. The joint statement said: "Selenium pollution from Duke’s coal ash takes food off the table of
North Carolinians who count on Sutton Lake to feed their families—and
fish off fishermen’s lines." (Read more) (Eco Watch photo: The bottom photo is a normal bluegill; the top is one deformed from Sutton Lake)

Lemly and the conservation groups say that despite the change to natural gas, "the threat to the lake will continue," Downey writes. "They contend the only solution is to remove the coal ash from the open
ponds and dispose of it in a lined landfill to prevent selenium and
other pollutants from leaching into the Cape Fear River and into the
lake. Lemly says he was unable to directly study the effects of the selenium
on bass, carp and catfish because he could not find sufficient numbers
of young fish of those types to perform a valid study. But he says the
significant impact on bluegill—causing serious deformities that are
severe enough to cause more than 30 percent of the bluegill population
to die annually—indicates other species are affected as well."

Duke, which closed the coal-fired plant last month and replaced it
with a natural-gas plant, rebutted the report, Downey writes. The company
said in a statement: “Duke Energy has complied diligently with its
water discharge permit,
and the Sutton plant had a long history of safety and high operational
excellence. State permitting experts write permits in a way that ensures
lakes and rivers are well protected. In more than three decades of sampling using well accepted scientific
techniques and observing hundreds of thousands of fish in Sutton Lake,
Duke Energy biologists have not observed the health effects described in
today’s report and find the report’s claims highly suspect. We routinely sample water quality in the Cape Fear River,
which continues to be good quality with no concerns for fish
populations or aquatic life.” (Read more)

Oregon state economist Mark McMullen expressed his concern that the "fast-aging rural population hinders economic growth and could lead to a
long-term downward spiral of labor and job shortages in rural areas," Yuxing Zheng reports for The Oregonian. In 2010, deaths outnumbered births in 13 Oregon counties, all of them rural. (State Office of Economic Analysis graphic; click on image for larger version)

McMullen, speaking Wednesday at the Human Service Coalition of Oregon's annual meeting, said "Rural Oregon is aging incredibly fast, much more so than the rest of
the state, who are able to continue to attract these young, working-age
households. Once you start losing the work force, it’s
hard to talk firms into setting up shop in your rural area. With no
jobs, you're not going to get any young migrant
families. With no workers, you get no jobs, and this becomes a very
negative cycle."

Some say the best long-term solution "is to boost logging and tap natural resources available in rural counties," Zheng writes. Democratic Senator Ron Wyden last week introduced his proposal to boost logging on more than 2 million acres of Oregon & California Railroad forest lands. "Until timber executives, environmental groups and federal lawmakers
reach a long-elusive agreement, Oregon might need to intervene in
struggling rural counties. Under the terms of a law passed this year, Democratic Gov. John Kitzhaber—with the approval of county commissioners—can impose taxes to maintain basic public-safety services. The state would match any of
the taxes imposed by the governor." (Read more)

Wednesday, December 04, 2013

UPDATE: "Farm bill negotiators broke new ground in an hour-long meeting Wednesday
morning," and the American Farm Bureau Federation "urged rival commodity
groups to 'close ranks' behind a final package this winter," David Rogers reports. "After weeks of floundering there was genuine hope that the pieces of a deal could be coming together."

The inability of parties and lobbies in Congress to see eye-to-eye on key points that affect millions of Americans is delaying the Farm Bill, and threatening to kill it, David Rogers reports for Politico. "Cotton and rice recently took a shot at corn and soybeans in a letter
about proposed payment limits in both bills," Rogers notes. "Corn and beans went
directly after House Agriculture Committee Chairman Frank Lucas
(R-Okla.) last week — threatening to kill the Farm Bill and seek a
two-year extension that would run past his tenure as chairman."

Instead of getting closer to agreeing on a bill, the House and Senate conference committee members seem to be getting farther apart, with tensions rising as politicians and lobbyists vent their frustrations with each other, Rogers writes. Lucas told him, "The traditional coalition has broken down." Rogers adds: "And to a surprising degree, commodity groups are instead picking sides
between Lucas and Senate Agriculture Committee Chairwoman Debbie
Stabenow (D-Mich.)."

And it's not just politicians hashing out their differences, but lobbies, such as the National Corn Growers Association and American Soybean Association, which sent a letter to top Congressional negotiators that some took as a threat, Rogers reports. "By suggesting a full two-year extension of current farm programs, NCGA
and ASA were seen as running out the clock on Lucas’s chairmanship,
which is slated to end with this Congress a year from now." Lucas told Rogers, "For some folks to believe they don’t have to be part of the family
anymore makes it a little difficult. As chairman, I’m kind
of like a parent sitting at the table. I’m trying to make sure
everybody gets their fair portion as the plates go around. I’m trying to
make sure the biggest kid doesn’t shove all the little kids off the
bench."

Rogers writes, "Farm bill infighting among rival commodity interests is
nothing new. But the bad blood and distrust now are exceptional. Indeed, unlike the last two farm bills, Lucas and Stabenow have
significantly less money for the commodity title. The House has already
defeated one farm bill this past summer. And the talks now are focused
on how to reconcile two competing visions of a new farm safety net to
replace the current system of direct cash payments to producers.
In this context, the continued infighting is not just bloody — it could prove self-defeating."

If and when agreement is found, "It’s almost certain the new Farm Bill will include two options in its
commodity title: a Senate plan geared to revenues, a House alternative
keyed more to production costs," Rogers writes.
"Both promise to save money, but each has run into trouble for
insisting that farmers be paid on what they actually plant — not
according to the artificial 'base acre' formula used now for direct
payments." (Read more)

The ranking Republican on the Senate Agriculture Committee, Thad Cochran of Mississippi, has "grown increasingly skeptical" of that approach, Agri-Pulse reports, in a story that lays out five big reasons the bill may not pass: A breakdown among the chairs and ranking members, lack of a "sweet spot" for a compromise on food-stamp cuts, dairy issues that divide Lucas and House Speaker John Boehner, finding a House majority for any compromise bill, and the possibility that President Obama would veto the bill if food-stamp cuts are too high. Agri-Pulse is subscription-only, but offers a trial here.

Endangered Mexican gray wolves could soon be free to roam safely throughout large parts of New Mexico and Arizona. The Blue Range Wolf Recovery Area, managed by the U.S. Fish and Wildlife Service, was introduced in 1998 when there were an estimated four wolves in Arizona and none in New Mexico, according to the agency. In 2012, there were an estimated 75 wolves, with 37 in Arizona and 38 in New Mexico, and an estimated three breeding pairs. Of the 92 Mexican gray-wolf deaths from 1998-2012, the agency reports that 50 were illegally killed by hunters and 14 were killed by vehicles. (U.S. Fish and Wildlife graphic)

The proposal would allow wolves to roam all of Arizona and New Mexico between Interstates 10 and 40, while new releases would still be restricted to the Blue Range Recovery Area, Joanna Dodder Nellens reports for The Daily Courier in Prescott, Ariz. "This change is part of an August lawsuit settlement reached between the Fish and Wildlife Service and the Center for Biological Diversity," she reports. "The settlement also stops the Fish and Wildlife Service plan to trap Mexican gray wolves that roam into the U.S. from Mexico."

"The federal proposal would keep the Mexican gray wolf's designation as 'non-essential experimental' so ranchers and wildlife officials could continue to kill them for killing livestock or trap them for roaming outside their designated range," Dodder Nellens writes.
"While the federal proposal would list the Mexican gray wolf as an endangered subspecies, it also would remove the other gray wolves from the list of endangered species." (Courier photo by Les Stukenberg: A Mexican gray wolf at the Heritage Park Zoological Sanctuary in Prescott)

"The wolves can't become self-sustaining in the Blue Range Recovery Area because only about 6,000 acres includes its historical range and wolves already inhabit about 4,500 acres there," Sherry Barrett, Mexican gray wolf recovery coordinator for the Fish and Wildlife Service, told Dodder Nellens. However, the larger roaming area would allow the introduction of more wolves. About 300 wolves are held captive in 52 facilities, Dodder Nellens reports.

It's not groundbreaking news that rural areas are struggling to find young doctors willing to join practices, or set up their own practices. But Charlotte Albright of Vermont Public Radio highlights a new concern that concerns rural areas in the state, and could be one that affects rural areas across the nation. With health reform providing insurance to more people, more Americans could soon be seeking a primary-care physician. But in places like rural Vermont, there aren't enough such physicians to go around. In fact, many of the state's rural doctors no longer accept new patients, because they can't handle the extra workload, Albright reports. And with few younger doctors moving in, the average age of current doctors like Joe Hebert (above), who considers himself semi-retired, and spends part of each winter in Arizona, keeps getting older.

Paul Bengtson, CEO of Northern Vermont Regional Hospital in St. Johnsbury, population 6,300, told Albright: "There won’t be enough primary physicians and
primary provides to fill the gap as quickly as it will need to be
filled. . . . We haven’t taken any new patients in three years, just because we
don’t have the manpower, as our patients are aging and getting more
complicated and sicker to do the sort of medicine we want to do and
bring keep bringing people into the fold.”

A 2012 survey by the Vermont Area Health Education Center found that "one half of Vermont’s primary care physicians and two-thirds of
internists either limited or closed their practices to new patients in
2012," Albright writes. Another survey, by the state Department of Health, "shows that in half of Vermont’s counties, about a quarter of primary
care physicians are over the age of 60."

Vermont's plan to solve the problem is similar to what other states have tried, or are proposing: recruiting medical students to rural areas, and offering to help them repay school loans, Albright writes. David Reynolds, who recently retired as deputy director of health-care reform policy, told Albright, “It’s a simplified system, one payer,
paying equitable rates, I think we’ll have something that will draw
people here because they can practice medicine, not money." Albright adds, "But where the money will come from to create a universal health care
system is still a big question. Meanwhile, the primary doctor shortage
is getting worse not better, in rural Vermont." (Read more)

Colorado residents continue to stick to their guns. In a September recall election, voters ousted two Democratic state senators who supported gun-control bills passed earlier the year, replacing those senators with pro-gun Republicans. Last week, unhappy voters didn't need a recall election to get rid of Sen. Evie Hudak, as the Democrat from suburban Denver, who also supported gun-control laws, resigned amid calls for a recall election, Kurtis Lee and Lynn Bartels report for The Denver Post.

Hudak's decision means that instead of a recall election, where Republicans could have elected a pro-gun candidate, Hudak's successor will be a Democrat named by a committee, the Post reports. And that means that Democrats will continue to hold an 18-17 majority in the Senate, at least until Hudak's successor has to run for re-election in 2014. (Read more) The committee of 70 Democratic precinct leaders, will choose next week between a pair of politicians who have said they support background checks for guns, Lee reports.

Anyonewho has worked at a newspaper in recent years knows that lay-offs, furloughs and budget restraints are nothing out of the ordinary. Still, it's a shock to the system any time a well-regarded news organization cinches the belt straps a little tighter, with employees taking the brunt of the costs. Western Communications, which owns six community newspapers in Oregon and two in California, announced last week it will no longer provide health insurance to its 280 employees, citing rising costs for the decision, Jim Romenesko reports. He also reports that Shaw Media, which publishes about 100 print and digital publications in Illinois and Iowa, is cutting the workweek for all employees from 40 to 37.5 hours.

Western Communications president Gordon Black told Romenesko: "The alternative is a hell of a lot of bodies” being laid off, “and we’ve
tried to maintain the workforce. We believe if we don’t
create the content, we start the death spiral.”

Western, which emerged from bankruptcy protection last year, cut 10 percent of its staff in 2012, David Nogueras reports for Oregon Public Broadcasting. "Throughout the entire recession, the company managed to avoid making
layoffs. Ironically, the high foreclosure rate had something to do with
that. Papers like the Bulletin made a lot of money from the legal
notices required by Oregon’s non-judicial foreclosure process. But in an
article posted on the Bend Bulletin’s website, publisher Gordon Black
says that money has suddenly all but disappeared."

"Black says the company keeps an insurance policy in the event an
employee’s claims exceed $100,000 in a year. But he says the company
remains financially exposed if numerous employees get sick simultaneously," Nogueras writes. "Black says while recently enacted provisions of the Affordable Care Act
didn’t directly drive the decision, he says the company would have been
forced to drop its coverage in 2015, the year the employer mandate goes
into effect." (Read more)

Shaw Media will begin the 37.5-hour workweek Jan. 1. President John Rung said in a memo to employees: “The company continues to battle a challenging revenue environment, and
we face increased costs in health care. The standardization of the workweek will provide a
temporary reduction in expenses as we strive to improve our financial
performance. This move will also allow us to save jobs across the
company while continuing to find ways to better serve our customers. It
is our intention to adjust wages as our performance improves.” (Read more)

Tuesday, December 03, 2013

Emergency-room doctors treating children in rural areas are less likely to make critical errors when they incorporate telemedicine, the assistance of critical care specialist through videoconferencing, according to a study by researchers at the University of California DavisChildren's Hospital, published in Pediatrics. The study, which looked at 234 children who were treated for severe illnesses and injuries at eight rural hospitals in Northern California between 2003 and 2009, found that the wrong dose or wrong drug was administered 3 percent of the time when telemedicine was used, 11 percent of the time when local doctors talked to a specialist over the phone, and 13 percent of the time when a specialist wasn't consulted, Genevra Pittman reports for Reuters. (UCDCH photo)

Dr. James Marcin, the study's lead author, told Pittman that comparing telemedicine to a phone consultation
is "the difference between the doctor coming in to do an
office visit with you with his or her eyes closed, versus with his or
her eyes open."

Of the 234 patients studied, telemedicine was used in 73 cases, with doctors administering 146 drugs, five of which turned out to be wrong for the patient's condition or were given incorrectly, Pittman writes. Phone consultation was used in 85 cases, with 18 errors among the 167 drugs administered. No consultation was used for the remaining 76 patients, with 16 errors out of 128 drugs administered. Dr. Alejandro J. Lopez-Magallon told Reuters: "The amount of information that you can gather
in a telemedicine consultation is typically much richer than what you
can gather from a telephone conversation. Also, the
level of interaction with the remote care team widens because you're not
talking with a single person on the other side - you can interact with
the remote physician or physicians and nursing staff, support staff and
the patient and family themselves." (Read more) To read the study click here.

In the church where I was married in Connersville, Ky., a town of 100 just outside the 6,400-person town of Cynthiana at the northern edge of the Bluegrass, it's not uncommon to look at the posted weekly attendance and see it numbering in the 20s or 30s, with numbers going down in winter when roads are slick and the mostly older members are put off by weather conditions. Sadly, numbers are also dropping because many longstanding members have passed away and few younger members are joining the church, especially with many people leaving rural areas for urban ones. That's a problem that's affected rural churches for decades, and is having a major impact now on churches in and near Parker, S.D., Leland Steva reports for KELO-TV in Sioux Falls.

"Father Hal Barber leads two Catholic churches in Parker and Marion," Steva reports.
"After 40 years, the priest is seeing a decrease in attendance in one of
his churches, especially in the younger generation." Barber told Steva, "The population of the Marion church is decreasing as a whole. We
only have perhaps maybe nine children, all very young, and so we don't
worry about or think about religious education."

As a result, "religious orders are leaving the Diocese of Sioux Falls to deal with
declining numbers of vocations and increased retirements," Steva reports. The diocese "does have a plan in place to counteract the trend; some parishes will be merged, but none will close." That's good news, considering more than 100
churches have closed their doors in the 125-year history of the diocese, according to its records, Steva reports. (Read more)

Coal companies in Appalachia, hit harder by market and regulatory forces than any other region in the U.S., hope to cash in by selling captured mine methane to companies in California, "the only place in the U.S. where there is a limit and a price on carbon," Anya Litvak reports for the Pittsburgh Post-Gazette. "There may be enough coal mine methane in the U.S. to offset 60 million
metric tons of carbon dioxide over a 10-year period, according to the
California Air Resources Board. At $10 a ton, that's $600 million in new
money for coal companies and their project partners."

The first project would be at Consol Energy's Enlow Fork mine in Washington County (Wikipedia map), which "would offset 201,000 tons of carbon dioxide," Litvak writes. How it works is that Verdeo, a developer of clean energy projects, would "pay Consol for the use of its ventilated air, destroy the methane in
that airstream and sell the credits generated from that to companies in
California. Because greenhouse gas emissions contribute to global, not
regional, warming, projects anywhere in the U.S. qualify under
California's system as long as they are approved by the California Air
Resources Board."

And there's plenty of methane waiting to be sold. "The air coming out of the Enlow mine is about 0.8 percent methane,
but there's 181,000 cubic feet of it being ventilated each minute," Litvak writes. At Consol's McElroy mine in Marshall County, West Virginia (Wikipedia map), "the air is
1.2 percent methane, and 209,000 cubic feet of it is released
each minute. Destroying that methane offsets the emissions of a 50
megawatt coal plant each year."

The only hurdle is that critics "have argued that awarding credits to coal-mine methane would deflect
resources from greener technologies with a more local impact," a fear that stalled a decision by the Air Resources Board in October, Litvak writes. But if the board approves a protocol, it will mean big money for coal companies, because of the higher cost of selling
into the California carbon market. "For a project the size of Enlow or McElroy, the difference between
selling on the voluntary market and selling into the California carbon
market is the difference between $300,000 and $3 million a year." (Read more)

The digital age has made it easier for people to get their work done more efficiently. And it's not just people working in offices, or at home, staring all day at a computer. Farmers have taken advantage of technology to make their lives easier "to track weather, map the
spreading of fertilizers and seeds, and follow prices for input and
services," Becky McKendry reports for the Great Lakes Echo. But broadband service isn't always available in rural areas, and in places like rural Michigan, where broadband is severely lacking, farmers are having a hard time getting connected and keeping up to date with the rest of the tech-savvy world.

Hope may be on the way in the form of Connect Michigan, "a public-private partnership with the Public Service
Commission that works with counties to create plans to improve
Internet services. The plans include actions such as locating federal
and state funding and reaching out to community leaders to promote
projects for expansion," McKendry writes.

"Around one-third of rural households and farms nationwide lack broadband
Internet, according to the most recent report from the U.S. Department
of Agriculture," McKendry writes. "Although current state-by-state numbers are
unavailable, the department once ranked Michigan rural areas among the
nation’s worst for broadband access in 2008-09." (Connect Michigan graphic: 67 percent of state residents have adopted broadband, but only 50 percent of rural residents have)

That doesn't mean Michigan farmers aren't interested in getting connected. In fact, the opposite is true. "During the days of dial-up Internet, subscription rates at rural
farms were consistently higher than those of rural households, according
to the report," McKendry writes. "But dial-up isn’t cutting it anymore for agricultural operations,
experts say, and broadband access in Michigan’s countryside is often too
expensive or unavailable." (Read more)

Matthew Fluharty, founder of Art of the Rural, a collaborative organization seeking to build the field of rural arts, is expanding the blog into a full website, the Daily Yonder reports. "There was a need for a kind of site that could share a range of media and integrate all those forms seamlessly," Fluharty says. The new site is not only well-organized and aesthetically pleasing but also simple enough to load quickly in rural places where internet speed might be a concern.

Matthew Fluharty (left) of Art of the Rural spoke with North Dakota State art professor Michael Strang at the Rural Arts and Culture Summit this summer.

The original blog idea was born in 2008 through Fluharty's reflection upon his grandmother's life after her passing. The Art of the Rural's mission is "to help build the field of the rural arts, tell its stories and contribute to the emerging arts and culture movement across rural America," Fluharty says. He has learned that when it comes to blogging, process is as important as product.

Fluharty sees several themes emerging in rural America. "There's a real ethic of resourcefulness and improvisation," especially since the Great Recession. He also recognizes the growth of digital media to help celebrate place and tell stories about dispossession, extraction and inequity. "Put simply: rural culture has never been more accessible to the national consciousness than it is right now. It's an exciting cultural moment," Fluharty says. He is also pleased to see the increased engagement between rural culture and universities and is excited about the increasing multidisciplinary nature of this conversation. "This collaboration across disciplines is essential to the field of rural arts and culture but is equally vital to how, on the ground, we come together to articulate a shared future."

As a poet and an essayist, Fluharty values cultural work. "Arts and culture give us the metaphors and the imperative to communicate the value of our place," he says. Art can also help advance issues such as the expansion of broadband in rural areas. Although those in rural areas understand why these concerns are important, people in suburban and urban areas may not.

The new site for the Art of the Rural will feature some new digital tools, especially the Atlas of Rural Arts and Culture, which involves a program designed to build community by allowing people to add videos, postcards, photos, PDF images, audio and more. "We now can present a digital space where folks can peruse books, watch video, learn about cultural events, discover new artists and find out more about what's happening across the country—and, importantly, suggest items for us to include in these individual features. This is our ultimate goal: to collaborate with folks from across the country and to learn from them," Fluharty says. (Read more)

Photographer Builder Levy has spent a great deal of his life traveling to coal communities, mostly in Central Appalachia, to capturing the essence of living and working in its coalfield. His newest book, Appalachia USA, features 69 of his photos from southern West Virginia, Eastern Kentucky and Southwest Virginia, offering a wide array of photos from the the last 45 years, Paul Nyden reports for the Charleston Gazette. (Levy photo: Coal camp in Buchanan County, Virginia, 1970)

Builder Levy

Levy told Nyden: "I grew up during the Cold War and the McCarthy era in a family that
encouraged art and believed that the world needed to be changed. By the 1960s, people in our nation were marching in the streets
for civil rights at home and for peace in Vietnam. In communities throughout America, people were standing up for their
humanity and dignity and struggling for social justice. As an artist, I
needed to find a way to have a direct connection to these realities."

Levy photographs have appeared in more than 200 exhibitions, including "Images of Appalachian Coalfields," which had "70,000 visitors when it was displayed the West Virginia Culture Center during the spring of 1991," Nyden writes. He also published Life of the Appalachian Coal Miner in 1976, Images of Appalachian Coalfields in 1989, Builder
Levy Photographer in 2005 and 25 other books. His work can be viewed on his website.

Rural communities in Iowa that don't have exercise facilities have found a new way to keep senior citizens active and healthy. It's a new fad called "exergaming," which combines video games and exercise. In this instance, volunteer trainers show seniors 60 and older how to use a Nintendo Wii or an Xbox Kinect—which doesn't require a remote control—to become more active, Estela Villanueva-Whitman reports for The Des Moines Register. The program, "LIFE—Living (well through) Intergenerational Fitness and Exercise, is
part of an Iowa State University research study that has since expanded
to include a website with resources for older, rural Iowans to start
programs of their own." (ISU photo)

The program grew out of research by Sarah Francis, assistant professor of food science and human nutrition
at Iowa State. As she studied nutrition and
developed programs "to encourage behavior changes at congregate meal sites, she noticed a recurring theme of older adults
enjoying the Wii gaming system to bowl or play tennis," Villanueva-Whitman writes. "At one site, the
adults would wait in line because only one person knew how to use it."

The program began in 2011 with funding from the National Institute of Food and Agriculture’s Rural Health and Safety Education grants. "The pilot
program involved 46 participants, with 18 Iowa State University students
serving as trainers," twice a week for eight weeks, Villanueva-Whitman reports. Afterward, seniors continued exergaming on their own "and received
newsletters discussing additional ways to get physical activity and
focusing on cognitive exercise, brain health, social relationships and
nutrition." Currently, 92 seniors and 29 trainers participate in the program in 12 counties, with 10 more counties having signed up to start programs. The goal is to get 400 seniors and 80 trainers involved. (Read more)

Monday, December 02, 2013

The Patient Protection and Affordable Care Act brought funding changes and political battles that are threatening rural hospitals in Republican-controlled states that did not expand Medicaid. In rural counties around Nashville, "Administrators have been laying off workers, reducing services and worrying about the future," Tom Wilemon writes for The Tennessean. Some hospitals may even have to close. They are losing millions of dollars in federal funds that wil no longer flow through TennCare, Tennessee's Medicaid program.Henry County Medical Center Chief Executive Tom Gee said 8,000 more people in the rural counties the hospital serves could be covered with expansion of Medicaid. "He described the financial problems exacerbated by political conflicts over the health law as 'the most serious threat to our institution' in the 23 years he has been at the helm," Wilemon writes. The hospital not only lost $1.2 million last year but also had to cut 25 employees in October. "Our future survival is heavily dependent on expansion of Medicaid and signing people up in the health exchange," Gee said. "That's the only place we're going to replace the lost volume and lower reimbursements we're seeing right now."

The Tennessee Hospital Association lobbied for Medicaid expansion last spring, but Republican Gov. Bill Haslam refused. "The vast majority of our hospitals that are financially distressed right now are in our rural areas," THA President Craig Becker said. Wilemon reports, "The federal health law reduced reimbursements to Tennessee hospitals by $5.6 billion over the next 10 years. But the state hospital association estimates that Tennessee would receive $6.4 billion in new federal funds during the first 5.5 years of Medicaid expansion."

"This has real impact. It is serious," said Randy David, chief executive officer of NorthCrest Medical Center in Springfield. Even indecision and passivity are dangerous. It comes at a real cost. That is the human cost." (Read more)

The danger of oil pipelines, and the effect of spills on residents, can be seen firsthand in Mayflower, Ark., where in March, an Exxon Mobil pipeline ruptured, sending 12,000 barrels of oil into the town of 2,300, and causing 22 homes to be evacuated. At least 17 lawsuits have been filed, and "the Pipeline and Hazardous Materials Safety Administration
alleged nine 'probable" violations of safety regulations related to the
spill and proposed more than $2.6 million in civil penalties" against Exxon, The Associated Press reports. To make matters worse, residents in the subdivision who were hit hardest by the spill are fleeing the neighborhood, with 29 of 62 homes having been "sold to Exxon under its buy-out program or are on the open market," Sam Eifling and Zahra Hirji report for Inside Climate News. (KATV photo: Homes for sale in Mayflower)

"Shortly after the company was notified of the safety allegations, Exxon
Mobil issued a statement saying that was still reviewing the notice and
had not determined what action it would take," AP reports. "The company has 30 days from the date of the notice, Nov. 6, to
respond. It can also request an extension of time during that 30 days. Court litigation likely will take much longer. A
lawsuit filed by U.S. Attorney Christopher Thyer and Arkansas Attorney
General Dustin McDaniel is not scheduled for trial until Feb. 24, 2015. Exxon Mobil has asked the court to dismiss the case, a
request that has yet to be ruled upon by U.S. District Judge James M.
Moody. Mayflower business owners and residents in the area have filed the other lawsuits." (Read more)

Meanwhile, some Mayflower residents "were forced to sell because oil settled in their homes'
foundations, where removing it is nearly impossible," Eifling and Hirji write. "Others chose to
leave because of fears about potential health effects and the
marketability of their properties. Those who are staying aren't
necessarily doing so by choice: Many don't have enough equity to afford a
down payment on a new home in another suburb, according to local real
estate brokers." Homeowner Ryan Senia told Eifling and Hirji it was either sell to Exxon now or risk "holding onto that
thing forever. It's like selling a salvaged car—nobody wants to buy it." (Read more)

Media groups and transparency activists rallied for years for the establishment of the Iowa Public Information Board, which the Legislature created to provide handle complaints about government officials' obedience to state open-government laws. But the board's Nov. 14 rulings have frustrated some of the activists who originally supported it, Deron Lee writes for Columbia Journalism Review.

A few months before the board became law in 2012, Iowa received an "F" in the public-records accessibility category of a study by the Center for Public Integrity, Global Integrity and Public Radio International. "There's a whole sea of frustration in Iowa from citizens trying to get access to information they need," state Sen. Jeff Danielson said in 2011. "Iowans still wonder why officials still say 'no' to them when they ask for documents." Open-government advocates suggested an independent entity to which Iowans could appeal without going to court, as many states have, Lee writes.

As soon as the board opened for business this summer, it faced countless complaints from citizens, media groups and government officials. Its executive director, Keith Luchtel, said he anticipated approximately 300 cases every year, but at the current rate, it will receive 543 this year. But the number of cases isn't the biggest problem, Lee writes: "The executive, legislative and judicial branches [of state government] were exempted from IPIB scrutiny . . . The board's powers are limited by dozens more exemptions already written into Iowa's sunshine laws."

On Nov. 14, "IPIB dismissed petitions by The Des Moines Register, which asked for a ruling specifying that public-records requesters could not be charged for government workers' overtime pay; The Associated Press, which requested access to fired public workers' arbitration records; and a resident of Sanborn, Iowa, who argued that city officials there had violated the law by keeping a public-meeting notice behind locked doors for much of the legally mandated 24-hour period," Lee reports.

Board members said they were following the laws as written. One, Drake University professor Kathleen Richardson, said "One of the things this board is trying to do is look at gaps in the law and make recommendations for what can be changed." UPDATE, Dec. 4: IPIB Chair Bill Monroe, former executive director of the Iowa Newspaper Association, published an "op-ed" in the group's Bulletin.

Lyle Muller, the executive director of the Iowa Center for Public Affairs Journalism, fought for years for the creation of the IPIB. However, he isn't pleased with the board's Nov. 14 rulings, but public records accessibility has improved. "If nothing else, there is a greater awareness, and the state as a matter of policy said transparency is important. . . . Ask me in a year or so." (Read more)

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About The Rural Blog

This blog generally follows traditional journalistic standards. It's not about opinions, though you may read one here occasionally. It's about facts that we think will be useful to rural journalists, non-rural journalists who do rural stories, and others interested in rural issues. We don't try to be provocative, so we don't generate as many comments as most blogs with the level of traffic we have, but we certainly invite comments -- and contributions, to al.cross@uky.edu. Feel free to republish blog items, with credit to us and the original source.